Person creating this estimate:
Patient Name:
Patient ID:
| Consult fee Pathology In-house blood tests DefinitelyMaybe DefinitelyMaybe DefinitelyMaybe DefinitelyMaybe External blood tests Definitely Maybe Definitely Maybe Definitely Maybe Definitely Maybe Stimulation tets Definitely Maybe Definitely Maybe Urine & faecal tests (in house & external) Definitely Maybe Definitely Maybe Definitely Maybe Definitely Maybe Cytology & microbiology Definitely Maybe Definitely Maybe Definitely Maybe Definitely Maybe Histology Definitely Maybe Definitely Maybe Definitely Maybe Definitely Maybe |
| Imaging Radiology & Fluoroscopy Definitely Maybe Definitely Maybe Definitely Maybe Sedation requirement Definitely Maybe Radiology/Fluoroscopy external interpretation Definitely Maybe Ultrasound Definitely Maybe Definitely Maybe Definitely Maybe Ultrasound-guided procedures Definitely Maybe Definitely Maybe Definitely Maybe Definitely Maybe Sedation requirement Definitely Maybe CT/MRI (under GA) Definitely Maybe Definitely Maybe Definitely Maybe CT/MRI external interpretation Definitely Maybe Definitely Maybe Requested turnaround time if external interpretation selected Definitely Maybe |
| Medicine Other biopsy/miscellaneous procedures Def Maybe Def Maybe Def Maybe Def Maybe Sedation requirement Definitely Maybe Doppler blood pressure DefMaybe CGM Freestyle Libre DefMaybe DefMaybe Endoscopic procedures (under GA) Definitely Maybe Definitely Maybe Definitely Maybe |
| Tube placements Definitely Maybe Definitely Maybe Definitely Maybe Sedation requirement Definitely Maybe |
| Surgery Minimally invasive Definitely Maybe Definitely Maybe Orthopoedics joint Definitely Maybe Definitely Maybe Orthopoedics fracture Definitely Maybe Definitely Maybe Implant removal Soft tissue Definitely Maybe Definitely Maybe Neurosurgery Definitely Maybe Definitely Maybe Oncologic Skin & Flaps/ Punch biopsy/Abscesses/Wound exploration Definitely Maybe Definitely Maybe Bandage change Definitely Maybe Sedation requirement Definitely Maybe |
| Hospitalisation or post-op care Day stay General hospital Critical not ventilated Critical ventilated Isolation Oxygen Definitely Maybe Blood products PRBC Definitely Maybe Blood products Plasma Definitely Maybe P.I.C.U. (Underwood patients only) - PRESS SAVE FIRST then you can add PICU estimate below .......................................................................................................................................................................................................... |
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